The crime developed as a response to the Organ Bank Problem, a concept featured prominently in the early Known Space stories, particularly those set in the 21st and 22nd century. The Organ Bank Problem is a central theme in the novel A Gift from Earth, as well as the Gil Hamilton detective stories. As speculative fiction, the concept is a prime example of a Gedankenexperiment. It is an examination of the consequences to society of a new technology (in this case, the perfection of organ transplants) and an existing problem (organ shortage), carried to a logical conclusion.

The effect of technology on society is a recurring theme in Niven's stories.

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In Niven's universe, the technology to indefinitely sustain any human organ outside of the body was developed in the early 21st century, greatly simplifying organ transplants. This led to the creation of "organ banks" which, in theory, one could use to extend life indefinitely so long as a compatible organ had been donated at any point, as opposed to a complicated waiting list in combination with limited time to transport the organ to the recipient. In light of this, all forms of burial save complete harvesting of organs for transplant became illegal. This resulted in an increased quality of life, but quickly became its own problem; the banks required donors (i.e. dead people) to operate, but when the death rate is reduced (via the organ banks), the number of donors decreases. Thus, the supply of organs would continually reduce.

Compounding this problem, the high success rate of organ transplants tended to discourage research into other viable medical treatments. As a result, medical research was stagnated to a large extent, focusing primarily on improving transplants and little else. Repairing a failing organ (which could presumably fail again later) was considered secondary to the "complete" solution of replacing the failing organ.

An example in the Known Space universe was that anyone who wore eyeglasses was considered a reasonable candidate for an eye transplant (one or both); whereas in the real world, today's nearsighted population can solve the problem (temporarily) by wearing corrective lenses or (more permanently) by undergoing laser surgery.

On Earth, the problem led to a repressive society almost unrecognizable by today's standards. Since the average citizens wished to extend their lives, the world government sought to increase the supply by executing condemned criminals to supply the organ banks. When this failed to meet the demand, citizens would vote for the death penalty for more and more trivial crimes. First violent crimes, then theft, tax evasion, false advertising, and even traffic violations became punishable by the organ banks. This led to a disturbing discovery; in Niven's universe, many actions deemed "criminal" had a genetic propensity, and by harvesting these individuals for their organs, that propensity was eliminated from the gene pool. By the 22nd century, every crime on Earth merited the death penalty - but as a result of generations of summary execution, "Flatlander" psychology was irreversibly transformed into a society of near-total pacifism and submission to authority, which supplied no donors for the organ banks.

Further attempts to alleviate the problem by declaring, in stages, cryogenically frozen people to be dead in law (the so-called "Freezer Bills") and harvesting their organs also proved to be unsuccessful. The freezer vaults represented a finite supply and therefore were eventually exhausted.

The politically independent and individualist Belters took a different approach, as they viewed survival as a virtue in and of itself. Not only were they reluctant to turn otherwise healthy people into transplant stock, but accidents in space rarely resulted in viable organs to harvest. Thus, maintaining organ banks would require even more draconian measures than were used on Earth. Instead, their solution to the problem was to keep transplant prices as high as the market would allow. This, along with extensive research into prosthetics, reduced demand to meet the supply.

Colony worlds each took their own approaches. A notable example was the human colony of Plateau. Society was divided into a rigid caste system, with descendants of the Colony ship "Crew" holding absolute power over the descendants of the ship's passengers, or "Colonists". The Crew controlled the planet's entire industrial infrastructure, including all access to organs and transplants. Successive colonist resistance movements provided much of the material for the organ banks, crew were unlikely to be sentenced there. They in effect controlled both supply and demand by their absolute rule.

The crime of organlegging involves several aspects: abduction of unsuspecting persons, the harvesting of their organs, and finding customers to purchase the organs once they were acquired. Thus a successful organlegging gang required three groups of people, one to handle each aspect of the operation.

The first group (the "snatch men") usually consisted of young, tough, uneducated males, with just enough intelligence to capture a prospect, and get him or her to the harvesting facility alive without getting caught.

The second group were the "doctors", the ones who harvested the organs and kept them ready for transport to a customer at a moments notice. This was usually the safest aspect of the operation as the harvesting facility could be hidden in a remote location, and the doctors had little or no public contact.

The third group (usually referred to as "organleggers" proper) were the ones who found potential customers, and delivered the organs to them. They were salespeople and field surgeons at the same time. The advent of automated precision surgical equipment allowed them to transplant the organs on the spot and required minimal training to operate. This was by far the most dangerous aspect of the operation. Some customers would attempt to turn in the organleggers in a fit of conscience after receiving their transplant. At least one pair of organleggers were killed by a customer attempting to cover his tracks for another crime. For this reason, they changed their identities, faces, and other physical characteristics frequently—a simple process given that they can use their own stockpiles for cosmetic grafts.

The only way to end the organlegging problem was to reduce the demand for human organs. Given the desire of humans to extend their lives, the only way to reduce the demand was to find a substitute for transplant stock. However, the draconian anti-technology laws of the ARM hindered all developments. It was not until the mid-24th century that alloplasty, improved prosthetics, and most importantly, the ability to grow the needed organs by manipulating one's own DNA, ultimately made the organ banks obsolete.

It is later revealed that this process was helped along significantly by the covert influence of former Belter turned Protector: Jack Brennan.

The concept of organlegging has expanded beyond the Known Space settings. The fantasy/cyberpunk setting Shadowrun involves organlegger gangs, going not only organic organs, but cyberware too. Many in this universe are operated or supported by ghouls, who help in the cleanup.